INJECTION ALLERGEN IMMUNOTHERAPY FOR ASTHMA

FCAAIA Notes: Allergy shots change the way your body sees what you are allergic to from an allergic to a non-allergic immune response. This “immune deviation” is in essence the only potential “cure” for allergic airway disease which includes asthma and nasal allergies. For all intents and purposes, asthma and allergies are the same disease, affecting different ends of a unified airway. It surprises allergists (including this editor) that more primary care physicians and pulmonologists do not recognize the role that allergy shots play in the care of asthma. In fact, the most recent national guidelines for the diagnosis and management of asthma, written by pulmonologists and allergists published in 2007  indicates the importance of allergy shots. It recommends that ANYONE with persistent asthma and allergies who is 5 or older should be considered for injection therapy.

(Source: Medcape, January 26, 2011 http://www.medscape.com/medline/abstract/20687065?cid=med&src=nlbest Adapted from Abramson MJ, Puy RM, Weiner JM. Cochrane Database Syst Rev. 2010; (8):CD001186)

BACKGROUND: Allergen specific immunotherapy has long been a controversial treatment for asthma. Although beneficial effects upon clinically relevant outcomes have been demonstrated in randomised controlled trials, there remains a risk of severe and sometimes fatal anaphylaxis. The recommendations of professional bodies have ranged from cautious acceptance to outright dismissal. With increasing interest in new allergen preparations and methods of delivery, we updated the systematic review of allergen specific immunotherapy for asthma.

OBJECTIVES: The objective of this review was to assess the effects of allergen specific immunotherapy for asthma.

SEARCH STRATEGY: We searched the Cochrane Airways Group Trials Register up to 2005, Dissertation Abstracts and Current Contents.

SELECTION CRITERIA: Randomised controlled trials using various forms of allergen specific immunotherapy to treat asthma and reporting at least one clinical outcome.

DATA COLLECTION AND ANALYSIS: Three authors independently assessed eligibility of studies for inclusion. Two authors independently performed quality assessment of studies.

MAIN RESULTS: Eighty-eight trials were included (13 new trials). There were 42 trials of immunotherapy for house mite allergy; 27 pollen allergy trials; 10 animal dander allergy trials; two Cladosporium mould allergy, two latex and six trials looking at multiple allergens. Concealment of allocation was assessed as clearly adequate in only 16 of these trials. Significant heterogeneity was present in a number of comparisons. Overall, there was a significant reduction in asthma symptoms and medication, and improvement in bronchial hyper-reactivity following immunotherapy. There was a significant improvement in asthma symptom scores (standardised mean difference -0.59, 95% confidence interval -0.83 to -0.35) and it would have been necessary to treat three patients (95% CI 3 to 5) with immunotherapy to avoid one deterioration in asthma symptoms. Overall it would have been necessary to treat four patients (95% CI 3 to 6) with immunotherapy to avoid one requiring increased medication. Allergen immunotherapy significantly reduced allergen specific bronchial hyper-reactivity, with some reduction in non-specific bronchial hyper-reactivity as well. There was no consistent effect on lung function. If 16 patients were treated with immunotherapy, one would be expected to develop a local adverse reaction. If nine patients were treated with immunotherapy, one would be expected to develop a systemic reaction (of any severity).

AUTHORS’ CONCLUSIONS: Immunotherapy reduces asthma symptoms and use of asthma medications and improves bronchial hyper-reactivity. One trial found that the size of the benefit is possibly comparable to inhaled steroids. The possibility of local or systemic adverse effects (such as anaphylaxis) must be considered.

 

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